Cards

The fetal presenting part and uterus move downward in the maternal pelvis

Term

Anterior Fontanel

Definition

Larger

Diamond Shaped

3 cm x 2 cm

Closes by 18 months after birth

Term

Posterior Fontanel

Definition

Smaller

Triangular

1 cm x 2 cm

Closes by 6-8 weeks after birth

Term

When does fundal heigh drop?

Lightening

Definition

Fundal Height drops around 38 and 40 weeks

Term

Presenting Part

Definition

Part of the fetal body first felt by the examiner during a vaginal examination

Term

Presenting part - Occiput

Definition

Cephalic

Head first

Term

Presenting part - Sacrum

Definition

Breech

Buttocks or feet first

Term

Presenting part - Scapula

Definition

Shoulder

Shoulder first

Term

Vertex Presentation

Definition

Vertex

When the presenting part is the occiput

Most wanted

Term

Fetal Lie

Definition

Relation of the long axis (spine) of the fetus to the long axis (spine) of the mother

Term

Fetal Lie - Longitudinal

Definition

Cephalic or breech

Term

Fetal Lie- Vertical

Definition

Transverse

unable to deliver vaginally

Term

Fetal Lie - Oblique

Definition

Uncommon, typically converts to a longitudinal or transverse lie during labor

Term

Fetal Attitude

Definition

Relationship of the fetal body parts to each other

Term

General Flexion (want this)

Definition

Back of the fetus is rounded so the chin is flexed on the chest, the thighs are flexed on the abdomen, and the legs are flexed at the knees, arms are crossed over the thorax and the umbilical cord lies between the arms and legs

Deviations from normal flexion may cause difficulty in childbirth

Term

Biparietal diameter

Definition

Largest transverse diameter - indicator of fetal head size

In well-flexed cephalic presentation, the biparietal diameter will be the widest part of the head entering the pelvic inlet

Term

Fetal Position

Definition

Relationship of the presenting part to the four quadrants of the mother's pelvis

Term

Fetal Position

1st letter- location of the presenting part to the maternal pelvis

Definition

R - Right

L - Light

Term

Fetal Position

2nd letter - presenting part of the fetus

Definition

O - Occiput

S - Sacrum

M - Mentum (chin)

Sc - Scapula (shoulder)

Term

Fetal Position

3rd letter - location of the presenting part in relation to the maternal pelvis

Definition

A - Anterior (face toward spine)

P - Posterior (face toward pubic)

T - Transverse

Term

ROA

Definition

Occiput is the presenting part, located in the right quadrant of the maternal pelvis

Term

Fetal Station

Definition

Relationship of the presenting part of the fetus to an imaginary line drawn between the maternal ischial spines

Term

How do you determine fetal station?

Definition

Measure the degree of descent of the presenting part of the fetus through the birth canal

Measured in centimeters

If 1 cm above the ischial spines minus 1 (-1)

Level of the ischial spines zero (0)

If 1 cm below the ischial spines plus 1 (+1)

Birth is imminent when station is +4/+5

Term

Engagement

Definition

Indicates that the largest transverse diameter of the presenting part has passed through the maternal pelvis inlet into the true pelvis and usually corresponds with 0 station

Term

Passageway Pelvic types

Definition

Gynecoid - classic femal type

(most common easiest for baby to get out)

Android - resembles the male pelvis

Anthropoid - resembling the pelvis of anthropoid apes

Platypelliod - flat pelvis

Term

Primary Powers

Definition

Involuntary uterine contractions

Term

Secondary powers

Definition

Bearing down and pusing of the woman with a fully dilated cervix

Term

Doula

Definition

A woman who has received training and whose sole objective is to provide supportive care to women in labor

(massage, breathing, talk, hand on comfort tech)

Term

Contractions move downward over the uterus in waves

Definition

Term

Frequency

Definition

Time from the beginning of one contraction to the beginning of the next

Term

Duration

Definition

Length of contraction from the beginning to the end

Term

Definition

Term

Intensity

Definition

Strength of the contraction

Term

Intensity Maternal Perception

Mild

Definition

Feels like touching end of nose

Uterus is easy to indent at peak of contraction

Term

Intensity Maternal Perception

Moderate

Definition

Feels like touch to the chin

Uterus is firm at peak of contraction

Term

Intensity

Maternal perception

Strong

Definition

Feels like a touch to the forehead

Uterus is hard at peak of contraction - it cannot be dented

Term

Intrauterine Pressure Catheter (IUPC)

Definition

Membranes must be ruptured to use

Term

Adequate uterine pressure

Definition

50-75 mmHg

Term

Resting tone of uterus

Definition

Soft uterus, using palpation

<10 mmHg using IUPC

Term

Relaxation Period

Definition

Should be at least 30 seconds for re-establishment of maternal blood flow to intervillous spaces thereby restoring oxygen to fetus

Term

Placenta

Definition

If intrauterine pressure is greater than 50-70 mmHg, the maternal blood flow to the placenta (intervillous spaces) is stopped

If IUPC is 30 mmHg, the maternal blood flow from the placenta (intervillous spaces) is stopped

Term

Effective Contraction Pattern

Definition

Interval - every 2 minutes

Duration - 90 seconds or less

Intensity - moderate to strong

Relaxation period - at least 30 seconds

Resting tone - 10 mmHg or less and uterus is soft to palpation

Term

Primary Powers

Cervical dilatation

Effacement

Station (descent)

Definition

Cervical dilatation 0-10cm

Effacement 0-100%

Station (descent) -4 to +4

Engaged = 0 station

Term

Effacement

Definition

Shortening and thinning of the cervix during the first stage of labor

Cervix is typically 2-3 cm long and 1 cm thick

Only a thin edge of the cervix can be palpated once effacement is complete

Measured in percentage 0% - 100%

100% fully effaced

Term

Dilation

Definition

Enlargement or widening of the cervical opening

Diameter of the cervix increase from less than 1 cm to full dilation, 10 cm

When the cervix is fully dilated, it can no longer be palpated

Full cervical dilation marks the end of the first stage of labor

Term

Secondary Powers

Definition

When the presenting part reaches the pelvic floor, the contractions change in character to expulsive

Laboring woman feels an involuntary urge to push

She should only begin pusing when she feels the urge to push (Labor Down)

Duramorph (synthetic morphine), Benadryl or small doses of Narcan (itching)

First 24 hours will have pain relief from spinal opioids, IV medications/PCA

After 24 hrs:

D/C Foley-measure first void (6-8 hrs)

Ambulate (sit, march, walk) in hall

PO pain medications

Nurse montiros dressing/drainage til removal

Shower after dressing removed (physician removes)

Term

Incisional Pain Management

Definition

Splint incision when moving or coughing

Use relaxing techniques

Apply ice for the first 24 hours (even after), then heat as necessary

Term

Gas Pain Management

Definition

Walk

Do not eat or drink gas-forming items

Do not use straws increases gas

chew simethicone as prescribed

Lie on the left side

Rock in a rocking chair

Term

Dystocia

Definition

A long, difficult, or abnormal labor is known as dysfunctional labor, or dystocia.

Term

What is the second most common indication for cesarean birth after previous cesarean birth?

Definition

Dystocia

Term

When is Dystocia suspected?

Definition

When the characteristics of uterine contractions are altered or when progress in the rate of cervical cilation or progress in fetal descent and expulsion is lacking or failure to descend, not progressing as think she should

Term

Dystocia Causes

Powers

Definition

Ineffective uterine contractions or maternal bearing down efforts (most common cause of dystocia)

Term

Dystocia Causes

Passage

Definition

Alterations in the pelvic structure

HPV-genital warts blocking vagina

Obesity

Term

Dystocia Causes

Passenger

Definition

Fetal causes that include abnormal presentation or position, anomalies, excessive size, and number of fetuses

Ascynclitic (head not in correct position)

(OP) - occiputposterior - back labor

Term

Dystocia Causes

Position

Definition

Maternal position during labor and birth

(way she lies)

Term

Dystocia Causes

Psychological

Definition

Responses of the mother to labor related to past experiences, preparation, culture, heritage, and support systems

Not pusing, total anxiety, abuse issues

Term

Tachysystole

Definition

Hypertonic uterine dysfunction

defined as uncoordinated uterine activity

Term

Risk factors for Tachysystole

Definition

Augmented (stimulated) labor

Term

Definition

Term

Tachysystole Management

with reassuring FHR

Definition

Reposition to side lying

IV fluid bolus-500 ml

If uterine activity not returned to normal after 10 minutes, decrease Pitocin

Internal monitoring on people on Pitocin to detrmine sufficient pressure

Term

Influences on Fetal Heart

Definition

Utero-placental unit

Autonomic nervous system (stimulus)

Position, Epidural & Pitocin

Baroreceptors

Central nervous System

Chemoreceptor

Acidodic

Hormonal Regulation

Utero-placental Insufficiency

Head compression

Term

FHR Categories

Category I

Definition

Normal

Strongly predictive of normal fetal acid-base balance. They may be followed in a routine manner and no action is required.

Term

FHR Categories

Category II

Definition

FHR tracings are indeterminate. They are not predictive of abnormal fetal acid-base status, yet there is not adequate evidence to classify them as category I or III. They require evaluation and continued surveillance and reevaluation in the context of the clinical circumstances

Term

FHR Categories

Category III

Definition

FHR tracings are abnormal. They are predictive of abnormal fetal acid-base status and require prompt evaluation.

Depending on the clinical situation intrauterine resuscitation should be initiated.

Minimum or absent variability

Term

Category I FHR tracings include all of the following:

Normal

Definition

Baseline rate 110-160 bpm

Baseline variability moderate

Late or variable deceleration absent

Early decelerations absent or present

Term

Category II - Indeterminate

FHR tracings include all FHR tracings not categorized as category I or III

The abrupt increase in FHR with 15 bpm above baseline lasting for at least 15 seconds and less than 2 minutes from onset to return to baseline

Term

What causes accelerations?

Definition

Caused by increase in sympathetic nervous system

Term

What denotes acceleration in fetuses under 32 weeks?

Definition

An abrupt increase of 10 bpm for 10 seconds is considered an acceleration

Term

What are accelerations of FHR for more than 10 minutes?

Definition

A change in baseline rate

Term

Accelerations may be periodic or episodic and occur in association with fetal movement or spontaneously

Definition

Term

Stimulating Accelerations

Definition

If accelerations do not occur spontaneously, they can be elicited by fetal scalp stimulation or vibroaccoustic stimulation

Term

Decelerations

Categorized as:

Definition

Early, late, variable, or prolonged

Term

Early decelerations

Definition

related to head compression

A gradual decrease in associated with uterine contraction, the onset, nadir (lowest point), and recovery are coincident with the beginning, peak, and ending of the contraction

A mirror image

Considered benign

Term

Early Decelerations

Caused by:

Definition

Head compression resulting from:

Uterine contractions

Vaginal examination

Fundal pressure

Placement of internal mode of monitoring

Significance: Normal pattern, no intervention req'd

Term

Late Deceleration

Definition

Related to uteroplacental insufficiency

A gradual decrease (defined as onset of deceleration to the nadir in 30 or greater seconds); associated with uterine contraction delayed in timing, with the nadir of the decleration occuring after the peak of contraction

Begins after the contraction has started

Does not return to baseline until after the contraction is over

Ominous sign if uncorrectable or associated with absent or minimal variability or tachycardia

Term

Late Decelerations

Uteroplacental Insufficiency

Definition

Persistent and repetitive late decelerations indicate the presence of fetal hypoxemia stemming from insufficient placental perfusion during uterine contractions

The presence and degree of hypoxia are thought to correlate with the depth and duration of the deceleration, how abruptly it returns to baseline, and how much variability is lost during the deceleration

Term

Non-reassuring (abnormal) FHR patterns

Definition

Tachycardia, bradycardia, or unidentifiable/wandering

Absent variability

Absence of accelerations

Late decelerations

Fetal pulse-oximetry is not effective in determining fetal outcome-no change in C/S rate

X-inactivation-affected females are usually less severely affected compared to males

Females are more likely to transmit the affected allele to their offspring

Heterozygous females have a 50% chance of transmitting the variant allele to each offspring

May be lethal in males

Examples: Vitamin D- resistant rickets, fragile X syndrome

Few X-linked dominant disorders identified d/t lethality

Term

**X-Linked Recessive

Definition

Carried on the X chromosome

Females may be heterozygous or homozygous for traits

Males are hemizygous since they only have 1 X chromosome, with no alleles on the Y chromosome

Most often occur in male offspring

Male receives the disease-associated allele from his carrier mother

Female carriers have a 50% probability of transmitting the disease-associated allele to offspring

An affected male can pass the disease associated allele to daughters, not sons

The daughter will be a carrier if they receive a normal X from their mother

The daughter will only be affected if they receive a disease-associated allele on the X chromosome from both their mother and father

Examples: Hemophilia, color blindness, Duchenne muscular dystrophy

Term

Genetic Counselors

Definition

Provide non-directional (gives just facts & statistics but not what means) counseling about genetic testing

Provide information on risk for the future

Cancer predisposition

Prenatal

Especially age-related risk for chromosomal abnormalities

Prepared with a Master's degree in gentic counseling

Term

Genetic Evaluation

Definition

Diagnosis of a genetic condition

Family history

Physical exam looking for dysmorphology or other clues

Geneticists are physicians with fellow-ships in gentics

Term

Family history

Definition

At least 3 generations

Record current and past health status

Include mental illness (depression)

Pregnancy losses (miscarriage)

In addition to ones suggested

Term

Genetic Testing

Definition

Informed decision making

Non-directional counseling (give no opinion only info)

Term

Family Genes

Refer when 2+ are present

Definition

F family characteristics are obvious

G groups of anomalies (3 or more)

E extreme presentation (early onset or abnormally severe)

N neurologic abnormalities

E exceptional pathology (rare findings)

S surprising lab values (hypocalcemia, chromosomes, etc)

Term

Types of Genetic Testing

Definition

Diagnostic Testing-do I have the gene?

Carrier testing-do I carry the gene but my other gene prevents me from having the disease

Predictive testing-what are my chances of getting the disease

Pre-symptomatic testing-do I have the gene but it's just not affecting me yet, but certainly will (Huntington disease)

Predisposition testing-if the test is positive, it is not 100% that I will get the disease (BRCA 1)

Term

Nurse Role in Genetics

Definition

Provide emotional support to families during the genetic counseling process

Provide basic info about patterns of inheritance

Identify patients who might benefit from genetic information/services

Provide accurate information about what is involved in genetic evaluation/counseling before referral is made

Find accurate, current information about gentic information for the patient and family

Access to Credible Genetics Resources Network

Identify patient's current knowledge and find out what they need to know first and find it

Identify community resources for the patient and family

Maintain confidentiality

Protect privacy

Term

Effective Communication

Definition

Use child first language:

The child with Down syndrome

Not A Down's child

Use neutral words

Use gene alteration or gene mutation

NOT defective or mutant

Down syndrome NOT Down's Syndrome

Term

ELSI: Ethics, Legal, Social Implications

Definition

http://agree.mc.duke.edu/index.html

Accessible genetics research ethics education

Family impact

Target screening for populations with increased incidence of a particular genetic condition

Term

Discrimination

GINA

Definition

G genetic

I information

N non-discrimination

A act

Term

GINA Federal Legislation

Definition

This legislation would prohibit discrimination on the basis of genetic information with respect to health insurance and employment

GINA provides strong, enforceable protections against the misuse of genetic information-the definition of which includes family health history-in both health insurance coverage and employement decisions

Term

Equal Access for Genetic Services

Definition

Informed consent necessary prior to blood being drawn for testing

Target populations where a gentic disease has an increased incidence so that early screening and treatment can occur.

Term

Advocate for Insurance Coverage

Definition

Generally most insurance underwriters approve payment on a case by case basis